Non-communicable diseases (NCDs), including diabetes and hypertension, pose increasingly significant health, policy and financing challenges in Vanuatu, a lower middle income Pacific Island country. Pharmaceutical costs to Government are becoming unsustainable. We show how pharmaceutical cost to Government rise in large, step-wise, patterns as diabetes or hypertension progressively becomes more severe. For diabetes, pharmaceutical costs to Government increased more than four-fold from $5.59 per patient per year (pppy) to $24.55 pppy in Vanuatu in late 2012 as a person moves from regular testing of blood glucose levels to first stage oral medication. Pharmaceutical costs increased again to $ 367 pppy when insulin and other associated drugs are required. For hypertension, pharmaceutical costs to Government increased more than twelve times as the patient advances from first line drugs to additional drug therapy ($1.38 pppy to $17.58 pppy), eventually rising to $75 pppy if additional drugs are required. Progression of diabetes and hypertension to more advanced stages squeezes an already tight Government health budget. One patient requiring insulin absorbs the equivalent drug allocation of 76.4 other citizens. Only 1.31% of the total population could be treated with insulin, or 5.3% treated with the full regime of anti-hypertensive drugs, before the total Government drug budget for the country was fully spent. Primary and secondary prevention of diabetes and hypertension is therefore a particularly important policy priority. Every person who adopted a healthy lifestyle and was able to avoid diabetes or keep it under control would avert direct drug costs to Government of up to $367 per person per year. Those able to avoid or control hypertension through adopting healthy lifestyles would avert costs to Government for drugs of up to $ 75 per person per year: the equivalent of what the Government currently spends on average on 18 other citizens.